JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : February Volume : 6 Issue : 6 Page : 323-326

CLINICO-EPIDEMIOLOGICAL PROFILE OF BREAST CANCER PATIENTS IN CENTRAL KERALA

Jojo Vattappalllil Joseph1, Ranjith Bhaskar2

1. Consultant Surgical Oncologist, Department of Surgical Oncology, Caritas Cancer Institute, Kottayam, Kerala.
2. Junior Surgeon, Department of Surgical Oncology, Caritas Cancer Institute, Kottayam, Kerala.

Dr. Jojo V. Joseph,
Consultant Surgical Oncologist,
Caritas Cancer Institute,
Kottayam, Kerala.
E-mail: drjojovjoseph@yahoo.com
DOI: 10.18410/jebmh/2019/67

ABSTRACT
BACKGROUNDBreast cancer is the second most common cancer among women with increasing incidence. Mortality is higher in India compared to developed countries. A thorough knowledge of the epidemiological profile is imperative to formulate control strategies for a population.

MATERIALS AND METHODS
This is a 2-year retrospective study on diagnosed cases of breast cancer in central Kerala. Demographic data and risk factors are collected on a proforma and analysed.

RESULTS
All 150 patients studied were females and most belonged to the age group of 40-60 years. A breast lump was the commonest presentation (88%), most commonly, on the right side (70.6%) with a median duration of symptoms of 11 months. 46.6% patients had AJCC TNM stage III at presentation. 5.3% had a positive family history. Hormone replacement therapy was present in 2.6% and 6% had a history of prior breast malignancy.

CONCLUSION
Breast cancer in Kerala is more biologically aggressive disease than in the west with a widely different spectrum of presentation and behaviour. Compounding this is a late presentation in an advanced stage. More cases need to be detected early with routine health check-ups and periodic screening of high-risk groups for better disease control.

KEYWORDS
Carcinoma Breast, Epidemiology, Kerala.

How to cite this article

Joseph JV, Bhaskar R. Clinico-epidemiological profile of breast cancer patients in Central Kerala. J. Evid. Based Med. Healthc. 2019; 6(6), 323-326. DOI: 10.18410/jebmh/2019/67

BACKGROUND

Breast cancer, the second most common cancer in the world is the most frequent cancer among women.1 About 1 in 8 U.S. women (approximately 12%) will develop invasive breast cancer over the course of her lifetime.2 In 2018 in the United States, an estimated 266, 120 new cases of invasive breast cancer are expected to be diagnosed in women.3 India reports about 100,000 cases of breast cancer annually, with an estimated increased rate of 3% per year.

The death rates due to breast cancer are highest in India, surpassing China and USA and is a cause of concern.4

To plan and formulate sound cancer control strategies epidemiological profile is very essential. Unfortunately, there are no studies about the epidemiological profile of breast cancer among women in central Kerala. Hence the relevance of the study.

MATERIALS AND METHODS

This retrospective study, conducted at a tertiary care hospital in central Kerala, between January 2010 and December 2013 included one hundred and fifty diagnosed cases of breast cancer. Information was collected on a Performa from the medical records. Parameters studied included age and gender of the patient, presenting complaints, duration of symptoms, side and site of breast lump, age at menarche and menopause, age at first child birth, breast feeding, family history, hormone replacement therapy, previous history of breast lump and TNM stage at presentation.

 

RESULTS

150 patients diagnosed with breast cancer were included of which, there were no males. The demographic and clinical characteristics of the disease are shown in Table 1.

Majority of the patients were in the age group of 40-60 years (70.6%, median age 48 years), with the youngest being 25 years old and oldest being 78 years old. (Figure 1)

The duration of presenting complaints ranged from 7 days to 24 months, with a median of 11 months. 72.2% of patients had complaints lasting less than 6 months.

132 (88%) patients presented with a breast lump, 106 (70.6%) on the right side, and 72 (48%) in the upper outer 

quadrant of the breast. (Figure 2) One patient came with bilateral breast lump.

Twelve (8%) patients presented with blood stained nipple discharge without any lump. Six (4%) patients were detected to have breast cancer during routine health check-up.

On evaluation of the stage, 46.6% patients were diagnosed in AJCC TNM (7th edition) stage III at presentation and one (0.6%) patient had in situ disease.

On risk factor evaluation, 7 (4.6%) patients were nulliparous and 24 (16%) patients had not breast fed their children for more than twelve months. Age at menarche ranged from 9–18 years, with a mean of 12 years and 99 (66%) patients had menarche before 12 years of age.

86 (57%) patients were postmenopausal, with 4(2.66%) patients having menopause after the age of 55 years. 8 patients (5.3%) had a positive family history of breast cancer in single first degree relative, and 2 patients (1.3%) had a first full-term pregnancy after the age of 35 years.

Risk factors such as hormone replacement therapy was present in 4(2.6%) patients and 9(6%) patients had history of breast cancer with 1 patient having history of breast cancer on the same side. (Table 2).

 

Gender

Male

0

Female

150

Age (in years)

20-30

2

30-40

16

40-50

39

50-60

67

60-70

20

>70

6

Presenting Complaint

Lump

132

Nipple Discharge

12

Routine Health Check-Up

6

Duration of Symptoms

< 6 Months

104

6 Months - 1 Year

30

> 1 Year

10

Side

 

Right

106

Left

43

Bilateral

1

Site

Upper Outer

72

Upper Inner

3

Lower Outer

44

Lower Inner

26

Central

5

Disease Stage

Insitu Disease

1

Stage I

29

Stage II

70

Stage III

43

Stage IV

7

Table 1. Distribution of Study Subjects According to Demographic and Clinical Characteristics

 

Family History

Absent

142

Present

8

Previous History of Breast Cancer

Absent

141

Present

 

Opposite Side

8

Same Side

1

Age at Menarche

<10 Years

1

10 - 12 Years

98

12 - 14 Years

32

14 - 16 Years

8

16-18 Years

1

Age at Menopause

<45 Years

1

45-50 Years

121

50-55 Years

24

>55 Years

4

Hormone Replacement Therapy

Present

4

Parity

 

0

7

1

51

2

68

3

21

4

3

Duration of Breastfeeding

NIL

10

<6 Months

4

6 Months - 12 Months

10

12 Months - 18 Months

38

18 Months- 24 Months

51

>24 Months

37

Age at First Child Birth

<20 Years

12

21 -25 Years

77

26-30 Years

42

31 - 35 Years

10

> 35 Years

2

Table 2. Distribution of Study

Subjects as per Risk Factors

 

 

Figure 1

 

Figure 2

 

 

DISCUSSION

Breast cancer is predominantly a disease of females with female gender being the strongest non-modifiable risk factor. There was no case of male breast carcinoma in our study. Incidence of male breast cancer in literature is 1.4%.5

The mean age of breast cancer patients has been reported to be 50 to 53 years in various cancer registries located in different parts of the India.6 The mean age of occurrence of breast cancer amongst US white females has been reported to be 61.0 years.7 The mean age of occurrence of the breast cancer in our study is 48 years, showing that the disease occurs a decade earlier, as compared to western counterparts. The reason for which is to be evaluated further.

Various epidemiological studies carried out in India and western populations have identified various reproductive factors generally associated with breast cancer.8-10 The studies have consistently identified several risk factors, each of which is associated with increased exposure to endogenous and exogenous oestrogens. Early age at menarche, nulliparity, late age at 1st delivery, late age at menopause increase the risk of breast cancers.11,12

The results from our study also support the same.

The duration of presenting complaints ranged from 7 days to 24 months, with a median of 11 months. Commonest presenting symptom is breast lump like in many previous studies.13,14

Our study showed that disease presented mostly in stage II and III which accounted for 75.3% cases. It means that breast cancer is presenting at relatively late stage making prognosis poorer. This is in accordance with previous data.15,16

 

CONCLUSION

Breast cancer in Kerala is thus a far more biologically aggressive disease than in the west with a widely different spectrum of presentation and behaviour. Compounding this is late presentation in an advanced stage.

Current knowledge of breast cancer offers little prospects of primary prevention. Even though Kerala is the most literate state in India, only four percent of patients had their breast cancer detected by routine health check-up. Also, most cases had advanced presentation. This study reinforces the need to support health education regarding the warning signals of breast cancer and its early screening so that more patients can be diagnosed at an early stage and effective treatment can be given to these women and their lives can be saved. What we need are efforts made to detect breast cancer at the very early stage through periodic screening of high-risk groups either by physical self-examination or by self-breast-examination. More, larger studies are needed to investigate the epidemiology of breast cancer in youngsters in Kerala to formulate a better treatment plan. This will help us to provide better quality of life to breast cancer patients.

 

REFERENCES

  1. Anderson WF, Katki HA, Rosenberg PS. Incidence of breast cancer in the United States: current and future trends. J Natl Cancer Inst 2011;103(18):1397-1402.
  2. Breast cancer facts & figures. American Cancer Society. Available from: https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html
  3. Li CI, Anderson BO, Daling JR, et al. Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA 2003;289(11):1421-1424.
  4. Bagchi S. Breast cancer rises in India. CMAJ 2008;179(1):27.
  5. Benard VB, Saraiya MS, Soman A, et al. Cancer Screening practices among physicians in the national breast and cervical cancer early detection program. J Womens Health 2011;20(10):1479-1484.
  6. Saxena S, Rekhi B, Bansal A, et al. Clinico-morphological patterns of breast cancer including family history in a New Delhi hospital, India--a cross-sectional study. World J Surg Oncol 2005;3:67.
  7. Verdial FC, Etzioni R, Duggan C, et al. Demographic changes in breast cancer incidence, stage at diagnosis and age associated with population-based mammographic screening. J Surg Oncol 2017;115(5):517-522.
  8. Kami?ska M, Ciszewski T, ?opacka-Szatan K, et al. Breast cancer risk factors. Prz Menopauzalny 2015;14(3):196-202.
  9. Kamath R, Mahajan KS, Ashok L, et al. A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district. Indian J Community Med 2013;38(2):95-99.
  10. Tan MM, Ho WK, Yoon SY, et al. A case-control study of breast cancer risk factors in 7, 663 women in Malaysia. PLoS One2018;13(9):e0203469.
  11. Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer. Epidemiol Rev 1993;15(1):36-47.
  12. Rao DN, Ganesh B, Desai PB. Role of reproductive factors in breast cancer in a low-risk area: a case-control study. Br J Cancer 1994;70(1):129-132.
  13. Ayoade BA, Tade AO, Salami BA. Clinical features and pattern of presentation of breast diseases in surgical outpatient clinic of a suburban tertiary hospital in south-west Nigeria. Niger J Surg 2012;18(1):13-16.
  14. Mersin HH, K?na? V, Gülben K, et al. What has changed in the clinical presentation of breast carcinoma in 15 years? Ulus Cerrahi Derg 2015;31(3):148-151.
  15. Naeem M, Khan N, Aman Z, et al. Pattern of breast cancer: experience at Lady Reading Hospital, Peshawar. J Ayub Med Coll Abbottabad 2008;20(4):22-25.
  16. Wani SQ, Khan T, Wani SY, et al. Clinico-epidemiological analysis of female breast cancer patients in Kashmir. J Cancer Res Ther 2012;8(3):389-393.